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dc.contributor.authorLaslett, M
dc.contributor.authorOberg, B
dc.contributor.authorAprill, CN
dc.contributor.authorMcDonald, B
dc.date.accessioned2011-06-29T23:01:39Z
dc.date.available2011-06-29T23:01:39Z
dc.date.copyright2004-11-16
dc.date.issued2011-06-30
dc.identifier.citationBMC Musculoskeletal Disorders, vol.5, pp.43
dc.identifier.issn1471-2474
dc.identifier.urihttp://hdl.handle.net/10292/1365
dc.description.abstractBackground: Only controlled blocks are capable of confirming the zygapophysial joints (ZJ) as the pain generator in LBP patients. However, previous workers have found that a cluster of clinical signs ("Revel's criteria"), may be valuable in predicting the results of an initial screening ZJ block. It was suggested that these clinical findings are unsuitable for diagnosis, but may be of value in selecting patients for diagnostic blocks of the lumbar ZJ's. To constitute evidence in favour of a clinical management strategy, these results need confirmation. This study evaluates the utility of 'Revel's criteria' as a screening tool for selection of chronic low back pain patients for controlled ZJ diagnostic blocks.Methods: This study utilized a prospective blinded concurrent reference standard related validity design. Consecutive chronic LBP patients completed pain drawings, psychosocial distress and disability questionnaires, received a clinical examination and lumbar zygapophysial blocks. Two reference standards were evaluated simultaneously: 1.75% reduction of pain on a visual analogue scale (replication of previous work), and 2. abolition of the dominant or primary pain. Using "Revel's criteria" as predictors, logistic regression analyses were used to test the model. Estimates of sensitivity, specificity, predictive values and likelihood ratios for selected variables were calculated for the two proposed clinical strategies.Results: Earlier results were not replicated. Sensitivity of "Revel's criteria" was low sensitivity (<17%), and specificity high (approximately 90%). Absence of pain with cough or sneeze just reached significance (p=0.05) within one model.Conclusions: "Revel's criteria" are unsuitable as a clinical screening test to select chronic LBP patients for initial ZJ blocks. However, the criteria may have use in identifying a small subset (11%) of patients likely to respond to the initial block (specificity 93%).
dc.languageEN
dc.publisherBioMed Central Ltd
dc.relation.urihttp://www.biomedcentral.com/1471-2474/5/43
dc.rights© 2004 Laslett et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
dc.subjectClinical-features
dc.subjectFacet syndrome
dc.subjectInjections
dc.titleZygapophysial joint blocks in chronic low back pain: a test of Revel's model as a screening test
dc.typeJournal Article
dc.rights.accessrightsOpenAccess
dc.identifier.doi10.1186/1471-2474-5-43


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